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In Some Nations, Coronavirus Is Only One of Many Outbreaks - The New York Times

MEXICO CITY — A dengue epidemic ravaged Honduras last year, sickening over 100,000 people and leaving 180 dead. As this year began, officials braced for another surge in cases of the mosquito-borne disease and wondered how they would manage with their frail public health system and shortage of trained personnel.

Then along came the coronavirus, pitching the nation into a grueling, two-front public health battle.

“Horrible,” said Dr. Dinorah Nolasco, a top health official in northern Honduras, a region that has been particularly hard hit by both diseases. “These months have been tremendous.”

As the coronavirus pandemic stalks the globe, some nations, particularly in the developing world, find themselves under extraordinary strain as they simultaneously contend with other outbreaks, chronic public health problems and challenges posed by government mismanagement, poverty and armed conflict.

The all-consuming demands of the coronavirus, officials fear, could divert government focus and open the door to a possible resurgence of other illnesses.

In Latin America, where the number of coronavirus cases has been rising sharply, governments are trying to contend with new dengue outbreaks while holding onto gains in the fight against other infectious diseases. But at least nine countries in Latin America and the Caribbean have paused some of their immunization activities, officials said, threatening efforts to control diseases such as polio, tuberculosis and measles.

Credit...Daniele Volpe for The New York Times

Dengue is also bedeviling nations in Southeast Asia, like Indonesia, another country hard hit by the coronavirus. And in Africa, health officials are concerned about recent outbreaks of yellow fever, cholera, measles and Ebola, among other diseases.

In one alarming measure of the extent of the coronavirus’s disruption to global health strategies, vaccination programs in at least 68 countries have been “substantially hindered,” according to a statement released last week by the World Health Organization, Unicef and Gavi, a public-private partnership that helps provide vaccines to developing countries.

The suspensions could affect about 80 million children under the age of one and risk a resurgence of diseases like polio, measles, typhoid, yellow fever, meningitis, tetanus and cholera, the agencies said.

The causes for the disruptions include lockdowns that have impeded the movement of health care workers and patients, fear of coronavirus transmission in mass vaccination gatherings, inadequate vaccine supplies due to transportation delays and insufficient protective gear for health care workers, the statement said.

In some places, health care workers assigned to vaccination campaigns have been redeployed to respond to the coronavirus, officials said.

The pandemic, coming on top of other immense public health challenges, “has showed the vulnerabilities of many countries in different manners,” said Dr. Richard Mihigo, coordinator in Africa for the World Health Organization’s immunization and vaccines development program.

“Countries have been almost on their knees, paralyzed,” he continued. “It becomes very clear that they need to have a much more resilient health system in place to control any outbreak or to prepare for any outbreak that may come.”

Credit...Inti Ocon for The New York Times

The coronavirus took hold in Latin America well after it had started pummeling most of the rest of the world. During the first few months of the year, health officials had more immediate problems to contend with, including dengue.

In 2019, the disease, transmitted by the Aedes aegypti mosquito, had ravaged Latin America, which suffered its worst dengue epidemic on record with more than 3 million cases and more than 1,500 deaths.

The outbreak hit Honduras particularly hard, overwhelming a public health system that had already been weakened by budget cuts and pervasive corruption and was barely equipped to meet usual demands, much less an epidemic of record size. By the end of 2019, Honduras had suffered about 61 percent of the dengue deaths in Central America.

The highest number of dengue cases occurred in the department of Cortés, where efforts to control its transmission were further hampered by a lack of trained personnel and by the region’s ubiquitous criminal gangs, which for months blocked government health care workers from gaining access to some of the hardest-hit neighborhoods.

Dengue remains a major concern in Latin America and the Caribbean this year. According to the latest statistics from the Pan American Health Organization, about 1,426,000 cases have been recorded in the region so far, fewer than during the same period last year. But regional health officials fear this may be an undercount caused by the focus on the coronavirus and the disease it causes, Covid-19.

“Covid has been able to sometimes deviate attention from other pressing problems,” said Dr. Marcos Espinal, director of the department of communicable diseases at the Pan American Health Organization, based in Washington, D.C.

On Tuesday, Dr. Carissa F. Etienne, the director of the Pan American Health Organization, said the Americas, with more than 2.4 million Covid-19 cases and more than 143,000 deaths, had become the epicenter of the pandemic.

Credit...Victor Moriyama for The New York Times

In Honduras, the number of dengue cases this year is already outpacing last year’s tally — with the worst, perhaps, yet to come, officials said. The rainy season is just beginning, bringing more pooling and flooding and creating more potential breeding sites for mosquitoes.

“We’re expecting a much greater proliferation of the mosquito between July, August and September,” said Dr. Piedad Huerta, representative of the Pan American Health Organization in Honduras.

Health officials are now bracing for a repeat of last year’s crisis in Honduras, when the hospital systems in some regions were overflowing with gravely sick dengue patients, many of them children. Only this time, there is the additional problem of Covid-19.

The Coronavirus Outbreak

  • Frequently Asked Questions and Advice

    Updated May 28, 2020

    • My state is reopening. Is it safe to go out?

      States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.

    • What’s the risk of catching coronavirus from a surface?

      Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.

    • What are the symptoms of coronavirus?

      Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

    • How can I protect myself while flying?

      If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

    • How many people have lost their jobs due to coronavirus in the U.S.?

      More than 40 million people — the equivalent of 1 in 4 U.S. workers — have filed for unemployment benefits since the pandemic took hold. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.

    • Is ‘Covid toe’ a symptom of the disease?

      There is an uptick in people reporting symptoms of chilblains, which are painful red or purple lesions that typically appear in the winter on fingers or toes. The lesions are emerging as yet another symptom of infection with the new coronavirus. Chilblains are caused by inflammation in small blood vessels in reaction to cold or damp conditions, but they are usually common in the coldest winter months. Federal health officials do not include toe lesions in the list of coronavirus symptoms, but some dermatologists are pushing for a change, saying so-called Covid toe should be sufficient grounds for testing.

    • Should I wear a mask?

      The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.

    • What should I do if I feel sick?

      If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

    • How can I help?

      Charity Navigator, which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the American Red Cross, and World Central Kitchen has stepped in to distribute meals in major cities.

“It puts a double burden on the health services,” Dr. Huerta said. “Without a doubt, I think it isn’t easy for the country to be able to manage both things in a very efficient manner. It’s a very big challenge.”

The Honduran government has put out a call to contract more health care workers to deal with the growing coronavirus threat, officials said, while imposing stringent measures to try to control its spread, including closing the country’s borders, mandating a blanket curfew and severely restricting the ability of people to leave their homes.

Credit...Daniele Volpe for The New York Times

Dr. Nolasco, regional health director in the northern province of Cortés, said she has already been provided with more than 200 supplemental workers — doctors, nurses, microbiologists and others — to staff quick-response medical teams and conduct door-to-door education campaigns, cornerstones of her public health program to confront both the coronavirus and dengue.

But while she no longer has a problem with the criminal gangs, as she did last year, her teams are still having difficulty accessing some areas. Residents of certain neighborhoods have banded together to block the entrance of health care workers out of fear that they might be carrying the virus.

Dr. Nolasco said she and her staff members have been driven away by mobs wielding machetes and throwing stones. In one incident, workers trying to enter a neighborhood were doused with bleach, she said.

Some people afflicted by Covid-19 have been fearful of seeking out attention because they believe the disease is shameful and are embarrassed. Others are in denial that it is even a real phenomenon, she said.

Some patients, seriously sick with Covid-19, are seeking medical attention after it is too late. “People are arriving at the emergency room to die,” she said. “The fight now is education.”

Dr. Espinal said he worries about countries in Latin America and the Caribbean becoming overwhelmed by the coronavirus and “taking their eyes off” other health problems.

“Latin America has a great history of declining morbidity of infectious diseases,” Dr. Espinal said. “We don’t want to go back or to lose that achievement.”

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